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Ethics, Adjustments, and Cathartic Release

In yoga teaching, touch can be necessary, or ill-advised. The treatment of a student's emotional release can be equally sensitive. Thankfully, the health care profession provides some adaptable standards for teachers.

By Michael H. Cohen, J.D., M.B.A.

Sometimes it is better to err on the side of restraint—for example, when the student's expression of emotions becomes so overwhelming that it may threaten other students or make them feel unsafe. Respecting emotional boundaries can be seen as a form of nonmaleficence (see Legal Implications of Health Advice for Yoga Teachers, Parts 1 and 2)

On other occasions, it may be appropriate to encourage a limited cathartic release while providing an intimate space of emotional and physical safety. A student may unlock the body and mind by allowing currents of emotional energy, which the yoga pose has now released, to stir emotions that had previously been suppressed. The teacher must decide how to respond by using a combination of rational understanding, intuitive discernment, and spot-decision making that is sensitive to the student's needs and perceptions, the environment, and the whole situation.

The key ethical principles include not only the yoga instructor's duties of nonmaleficence and beneficence, but also the obligation to respect the yoga student's autonomy. In clinical care, this can translate into the right to make autonomous choices regarding one's own body and health. Informed consent, the obligation to disclose viable treatment options, is meant to help safeguard this right. In yoga teaching, this could translate into the obligation to give students the option to decline a standardized adjustment. A studio owner may consider a standardized adjustment to be nonmaleficent and beneficent, but such a process may violate the student's right (and ability) to feel centered in his or her own body.

Placing yoga teaching within the broader context of health care generally, the clash of these three ethical values of nonmaleficence, beneficence, and autonomy occurs frequently. In medicine, the physician may recommend a certain course of treatment as the most beneficent and nonmaleficent (e.g., surgery), while the patient may want to make an autonomous choice to try a complementary therapy (e.g., yoga, meditation, visualization, or nutrition).

A recent Institute of Medicine (IOM) report, Complementary and Alternative Medicine in the United States (see How Integrative Medicine May Affect Yoga Teaching and Business) addressed this ethical complexity in care giving. To complicate matters, the report considered two additional ethical values: pluralism, the value of honoring different healing traditions beyond the biomedical; and accountability, the value of making care sensitive to the needs of the public and all its constituent groups. In yoga teaching, these twin values can translate into: (1) recognition of the role of conventional medical care where it is needed; and (2) maintenance of high professional standards with sensitivity to the many facets of the yoga student's quest for wholeness and healing.

Complementary care modalities, including chiropractic and acupuncture, share these values. For example, if a patient's condition exceeds the chiropractor's skill and training, then the chiropractor has an ethical (and legal) duty to refer the patient to a medical provider for appropriate medical diagnosis and treatment. Sometimes patients and providers committed to holistic care dismiss conventional care—just as their medical counterparts may dismiss therapies such as acupuncture, chiropractic, massage therapy, and yoga as "all placebo." But the values of pluralism and accountability demand respect across disciplines and methods.

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